Nervous System Disease in Systemic Lupus Erythematosus: Current Status and Future Directions

The American College of Rheumatology's case definitions for 19 neuropsychiatric syndromes in systemic lupus erythematosus (SLE) constitute a comprehensive classification of nervous system events in this disease. However, additional strategies are needed to determine whether a neuropsychiatric s...

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Bibliographic Details
Published in:Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2019-01, Vol.71 (1), p.33-42
Main Authors: Hanly, John G., Kozora, Elizabeth, Beyea, Steven D., Birnbaum, Julius
Format: Article
Language:English
Subjects:
Abnormalities
Autoantibodies
Autoimmune diseases
Biomarkers
Brain
Chronic conditions
Cognitive ability
Cytokines
Immunopathogenesis
Inflammation
Ischemia
Lupus
Medical imaging
Mental disorders
Nervous system
Neuroimaging
Neurological complications
Neurology
Rheumatology
Systemic lupus erythematosus
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Summary:The American College of Rheumatology's case definitions for 19 neuropsychiatric syndromes in systemic lupus erythematosus (SLE) constitute a comprehensive classification of nervous system events in this disease. However, additional strategies are needed to determine whether a neuropsychiatric syndrome is attributable to SLE versus a competing comorbidity. Cognitive function is a clinical surrogate of overall brain health, with applications in both diagnosis and determination of clinical outcomes. Ischemic and inflammatory mechanisms are both key components of the immunopathogenesis of neuropsychiatric SLE (NPSLE), including abnormalities of the blood–brain barrier and autoantibody‐mediated production of proinflammatory cytokines. Advances in neuroimaging provide a platform to assess novel disease mechanisms in a noninvasive way. The convergence of more rigorous clinical characterization, validation of biomarkers, and brain neuroimaging provides opportunities to determine the efficacy of novel targeted therapies in the treatment of NPSLE.
ISSN:2326-5191
2326-5205
DOI:10.1002/art.40591